Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
John E. Wennberg, The Dartmouth Institute
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
Jeff Thompson, Washington State Health Care Authority
David Downs, Engaged Public
David Swieskowski, Mercy ACO Mercy Clinics, Inc.
Lisa Weiss, High Value Healthcare Collaborative
Kate Chenok, Pacific Business Group on Health
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Neil Korsen, MaineHealth
Larry Morrisey, Stillwater Medical Group
Charlie Brackett, Dartmouth-Hitchcock Medical Center
Grace Lin, Palo Alto Medical Foundation
Carmen Lewis, University of North Carolina
Leigh Simmons, Massachusetts General Hospital
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Karen Sepucha, Massachusetts General Hospital
Dale Collins Vidal, The Dartmouth Institute for Health Policy & Clinical Practice
Do you know where the term “shared decision making” was first used…or when the first center dedicated to its research and implementation was opened? Our infographic “Shared Decision Making through the Decades” will take you on a historical journey through four decades of shared decision making to understand where it is today and what the future might hold.
Angela Coulter: Getting the best value for patientsThe King's Fund
Dr Angela Coulter, Director of Global Initiatives, Foundation for Informed Medical Decision Making, spoke at The King's Fund's 'Reducing unwarranted variations in health care' conference, giving her expert opinion on how to give the best value for patients: with the right intervention, in the right place, at the right time with the right level of involvement.
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 24, 2013
Jeff Thompson, Washington State Health Care Authority
David Downs, Engaged Public
David Swieskowski, Mercy ACO Mercy Clinics, Inc.
Lisa Weiss, High Value Healthcare Collaborative
Kate Chenok, Pacific Business Group on Health
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Angela Coulter, Informed Medical Decisions Foundation
Dominick Frosch, Gordon and Betty Moore Foundation
Floyd J. Fowler, Informed Medical Decisions Foundation
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Neil Korsen, MaineHealth
Larry Morrisey, Stillwater Medical Group
Charlie Brackett, Dartmouth-Hitchcock Medical Center
Grace Lin, Palo Alto Medical Foundation
Carmen Lewis, University of North Carolina
Leigh Simmons, Massachusetts General Hospital
Aligning Incentives for Patient Engagement: Enabling Widespread Implementation of Shared Decision Making
May 23, 2013
Karen Sepucha, Massachusetts General Hospital
Dale Collins Vidal, The Dartmouth Institute for Health Policy & Clinical Practice
Do you know where the term “shared decision making” was first used…or when the first center dedicated to its research and implementation was opened? Our infographic “Shared Decision Making through the Decades” will take you on a historical journey through four decades of shared decision making to understand where it is today and what the future might hold.
Angela Coulter: Getting the best value for patientsThe King's Fund
Dr Angela Coulter, Director of Global Initiatives, Foundation for Informed Medical Decision Making, spoke at The King's Fund's 'Reducing unwarranted variations in health care' conference, giving her expert opinion on how to give the best value for patients: with the right intervention, in the right place, at the right time with the right level of involvement.
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
Federally Qualified Health Centers (FQHCs) provide primary care to over 24 million low-income Americans annually across over 11,000 sites. CHCI is a large FQHCs operating 14 primary care hubs and 204 sites serving over 100,000 patients annually. CHCI has integrated behavioral health, chiropractic care, and other specialties into primary care teams to improve outcomes for patients with chronic pain and complex conditions. Chiropractic visits at CHCI have increased from 453 in 2012 to over 9,000 in 2017 as the center has expanded integrated care models.
David Arterburn, MD, MPH, describes the Group Health experience in implementing decision aids as part of the shared decision making pathway. David also notes his publication in Health Affairs detailing the results of decision aid implementation.
The document discusses key aspects of implementing a disease management program including:
1. Encouraging early detection of diseases through various forms of advertising and utilizing guidelines from organizations like the CDC and WHO.
2. Providing incentives for patients to proactively manage their health like lower costs, support groups, and easy access to their medical records.
3. Addressing factors like ensuring quality of care through measurements, making facilities accessible, and emphasizing the importance of prescription management.
The document discusses improving the quality of medical decisions through shared decision making. It finds that currently many patients are not well informed about their medical options and risks when consenting to procedures. Shared decision making models aim to have clinicians and patients work together to make informed and values-based choices. Research shows patient decision aids that provide balanced information on options can improve decision quality by increasing patient knowledge and engagement in the process.
Presented in:
Pre-Conference Workshop on Communication Skills in Management of Cancer Patients,
World Cancer Day Conference & Expo 2015
by National Cancer Society of Malaysia
This document provides an overview and introduction to palliative care. It discusses that palliative care focuses on relieving pain, symptoms and stress of serious illness to improve quality of life. Palliative care is delivered by an interdisciplinary team and can be provided at any stage of a serious illness alongside curative treatments. The document summarizes research finding that palliative care can reduce costs by lowering hospitalizations and emergency visits while improving quality outcomes like symptoms and satisfaction. It also outlines strategies some health payers and organizations are taking to integrate palliative care, like targeting high-risk patients, dedicating case management resources and reimbursing providers.
Shared decision making involves doctors sharing information with patients about treatment options so patients can consider their options and make decisions together with their doctors. Decision aids like brochures and websites provide information to help patients make informed decisions by clarifying their values and preferences and guiding communication with doctors. Studies show decision aids increase patient knowledge and participation, align choices with values, and lower surgery rates without worse outcomes. Group Health implemented decision aid use for several conditions and is evaluating the impact on surgery rates, costs, and patient and provider experiences and identifying areas for improvement.
The document discusses complex patient journeys and tools to impact them. It begins by defining key dimensions and inflection points of patient journeys. Dimensions include the healthcare, disease/therapy, and human journeys. Inflection points are moments where outcomes are predicted. Behavioral science and cognitive-behavioral therapy can be used to intervene at these points by addressing cognitive, emotional, and behavioral barriers. A case study examines using these tools to help appropriate diabetes patients initiate insulin injections by addressing a patient's needle anxiety through cognitive reframing and desensitization exercises.
The document outlines a plan by Henry Ford Health System to implement routine dementia screening for senior patients aged 70 and older using online cognitive and behavioral assessments, with positive screens receiving further evaluation, diagnosis if appropriate, treatment, and referral to social services for patient and caregiver support. The goal is to test this screening program in two primary care clinics over 6 months before evaluating outcomes and potential expansion to other primary care practices.
At the end of the session patient/family champions as well as health authorities will leave armed with best practices, resources and ideas on how to open the door for patient/family engagement with health authorities and how to make the most of the time together.
This document discusses leadership for patient engagement in the NHS. While the NHS has focused on public consultations and one-off engagement initiatives, true culture change is required to make services patient-centered. Leaders face challenges in shifting beliefs, attitudes, and behaviors away from disease-focused care toward responsive, empowering care centered around patients' needs and preferences. Successful approaches require strategic, system-wide efforts to engage patients in shared decision-making, self-management of long-term conditions, and improving quality by understanding patients' perspectives. Isolated projects are easier than changing mainstream practice to prioritize the patient experience in all interactions and functions.
Shared decision making: Changing the relationship between doctor and patientMarkus Oei
This document discusses shared decision making between doctors and patients. It defines shared decision making as a process where doctors and patients make medical decisions together by considering evidence-based treatment options, their risks and benefits, and the patient's values and preferences. The document notes that while shared decision making improves health outcomes, many patients are not aware they have treatment choices and doctors do not always discuss patient preferences. It argues we need decision support tools, reliable patient information from various sources, and ways to effectively deliver this information to patients to facilitate shared decision making in clinical practice.
Dr. Judith Hibbard presents The Case for Patient Activation - Activate 2017 b...mPulse Mobile
Leading patient activation researcher, Dr. Judith HIbbard, delves deep into the research findings of countless studies to reveal the definition, value and outcomes of patient activation during Activate 2017.
The survey found that care coordinators need more support and resources to help patients. Nearly 70% rely on colleagues and 60% use personally collected materials for referrals. 98% want additional support like online referral resources and networking. Over half preferred online referral resources. The survey identified needs for improved training, current information, and abilities to understand learning styles and listen to patients. Care coordinators help with various needs including education, appointments, insurance, and translation. More support is needed for their important role in improving health outcomes.
Patient engagement is evolving to include a composite of practices that impact patient behaviors and health. Contemporary models of patient engagement include the HIMSS 5 phases of patient engagement and the Regional Primary Care Coalition's 6 dimensions of patient engagement. Meaningful Use Phase 3 identifies key priorities around patient access to health records and secure messaging. Barriers to patient engagement include defining engagement and integrating diverse engagement tools and technologies.
The document summarizes research on variations in medical practice and healthcare utilization in different geographic regions. It discusses studies in Vermont and Maine that found wide variations in tonsillectomy and hysterectomy rates that did not correlate with patient characteristics or health status. The Dartmouth Atlas Project also found significant unwarranted variations across hospital referral regions in procedures, spending, and end-of-life care intensity. Areas with more healthcare resources generally had higher utilization and spending but not better outcomes.
How to Engage Physicians in Best Practices to Respond to Healthcare Transform...PYA, P.C.
PYA Principal Kent Bottles, MD, spoke about physician engagement when it comes to value payment models during “How to Engage Physicians in Best Practices to Respond to Healthcare Transformation” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016. Dr. Bottles discussed the difficulty of weaning physicians from fee-for-service payment models and the often-unappreciated reasoning behind the shift to value-based payment models. He also highlighted MACRA, MIPS, patient satisfaction surveys, Physician Compare, and the ProPublica Surgeon Scorecard.
Seeking patient feedback an important dimension of quality in cancer careAgility Metrics
1) A patient satisfaction survey was conducted with cancer outpatients to identify areas for improvement. Wait times and contacting healthcare providers by telephone received the lowest satisfaction ratings, despite prior interventions to address wait times.
2) Patients followed by a nurse navigator reported higher satisfaction with wait times than those without a nurse navigator.
3) The survey found overall high satisfaction rates, but identified wait times and telephone contact as ongoing priorities for enhancing the patient experience.
Dr. Edward Wagner, Director (Emeritus) MacColl Center, Senior Investigator, Group Health Research Institute addresses the 2014 Weitzman Symposium on The Future of Primary Care
Federally Qualified Health Centers (FQHCs) provide primary care to over 24 million low-income Americans annually across over 11,000 sites. CHCI is a large FQHCs operating 14 primary care hubs and 204 sites serving over 100,000 patients annually. CHCI has integrated behavioral health, chiropractic care, and other specialties into primary care teams to improve outcomes for patients with chronic pain and complex conditions. Chiropractic visits at CHCI have increased from 453 in 2012 to over 9,000 in 2017 as the center has expanded integrated care models.
David Arterburn, MD, MPH, describes the Group Health experience in implementing decision aids as part of the shared decision making pathway. David also notes his publication in Health Affairs detailing the results of decision aid implementation.
The document discusses key aspects of implementing a disease management program including:
1. Encouraging early detection of diseases through various forms of advertising and utilizing guidelines from organizations like the CDC and WHO.
2. Providing incentives for patients to proactively manage their health like lower costs, support groups, and easy access to their medical records.
3. Addressing factors like ensuring quality of care through measurements, making facilities accessible, and emphasizing the importance of prescription management.
The document discusses improving the quality of medical decisions through shared decision making. It finds that currently many patients are not well informed about their medical options and risks when consenting to procedures. Shared decision making models aim to have clinicians and patients work together to make informed and values-based choices. Research shows patient decision aids that provide balanced information on options can improve decision quality by increasing patient knowledge and engagement in the process.
Presented in:
Pre-Conference Workshop on Communication Skills in Management of Cancer Patients,
World Cancer Day Conference & Expo 2015
by National Cancer Society of Malaysia
This document provides an overview and introduction to palliative care. It discusses that palliative care focuses on relieving pain, symptoms and stress of serious illness to improve quality of life. Palliative care is delivered by an interdisciplinary team and can be provided at any stage of a serious illness alongside curative treatments. The document summarizes research finding that palliative care can reduce costs by lowering hospitalizations and emergency visits while improving quality outcomes like symptoms and satisfaction. It also outlines strategies some health payers and organizations are taking to integrate palliative care, like targeting high-risk patients, dedicating case management resources and reimbursing providers.
Shared decision making involves doctors sharing information with patients about treatment options so patients can consider their options and make decisions together with their doctors. Decision aids like brochures and websites provide information to help patients make informed decisions by clarifying their values and preferences and guiding communication with doctors. Studies show decision aids increase patient knowledge and participation, align choices with values, and lower surgery rates without worse outcomes. Group Health implemented decision aid use for several conditions and is evaluating the impact on surgery rates, costs, and patient and provider experiences and identifying areas for improvement.
The document discusses complex patient journeys and tools to impact them. It begins by defining key dimensions and inflection points of patient journeys. Dimensions include the healthcare, disease/therapy, and human journeys. Inflection points are moments where outcomes are predicted. Behavioral science and cognitive-behavioral therapy can be used to intervene at these points by addressing cognitive, emotional, and behavioral barriers. A case study examines using these tools to help appropriate diabetes patients initiate insulin injections by addressing a patient's needle anxiety through cognitive reframing and desensitization exercises.
The document outlines a plan by Henry Ford Health System to implement routine dementia screening for senior patients aged 70 and older using online cognitive and behavioral assessments, with positive screens receiving further evaluation, diagnosis if appropriate, treatment, and referral to social services for patient and caregiver support. The goal is to test this screening program in two primary care clinics over 6 months before evaluating outcomes and potential expansion to other primary care practices.
At the end of the session patient/family champions as well as health authorities will leave armed with best practices, resources and ideas on how to open the door for patient/family engagement with health authorities and how to make the most of the time together.
This document discusses leadership for patient engagement in the NHS. While the NHS has focused on public consultations and one-off engagement initiatives, true culture change is required to make services patient-centered. Leaders face challenges in shifting beliefs, attitudes, and behaviors away from disease-focused care toward responsive, empowering care centered around patients' needs and preferences. Successful approaches require strategic, system-wide efforts to engage patients in shared decision-making, self-management of long-term conditions, and improving quality by understanding patients' perspectives. Isolated projects are easier than changing mainstream practice to prioritize the patient experience in all interactions and functions.
Shared decision making: Changing the relationship between doctor and patientMarkus Oei
This document discusses shared decision making between doctors and patients. It defines shared decision making as a process where doctors and patients make medical decisions together by considering evidence-based treatment options, their risks and benefits, and the patient's values and preferences. The document notes that while shared decision making improves health outcomes, many patients are not aware they have treatment choices and doctors do not always discuss patient preferences. It argues we need decision support tools, reliable patient information from various sources, and ways to effectively deliver this information to patients to facilitate shared decision making in clinical practice.
Dr. Judith Hibbard presents The Case for Patient Activation - Activate 2017 b...mPulse Mobile
Leading patient activation researcher, Dr. Judith HIbbard, delves deep into the research findings of countless studies to reveal the definition, value and outcomes of patient activation during Activate 2017.
The survey found that care coordinators need more support and resources to help patients. Nearly 70% rely on colleagues and 60% use personally collected materials for referrals. 98% want additional support like online referral resources and networking. Over half preferred online referral resources. The survey identified needs for improved training, current information, and abilities to understand learning styles and listen to patients. Care coordinators help with various needs including education, appointments, insurance, and translation. More support is needed for their important role in improving health outcomes.
Patient engagement is evolving to include a composite of practices that impact patient behaviors and health. Contemporary models of patient engagement include the HIMSS 5 phases of patient engagement and the Regional Primary Care Coalition's 6 dimensions of patient engagement. Meaningful Use Phase 3 identifies key priorities around patient access to health records and secure messaging. Barriers to patient engagement include defining engagement and integrating diverse engagement tools and technologies.
The document summarizes research on variations in medical practice and healthcare utilization in different geographic regions. It discusses studies in Vermont and Maine that found wide variations in tonsillectomy and hysterectomy rates that did not correlate with patient characteristics or health status. The Dartmouth Atlas Project also found significant unwarranted variations across hospital referral regions in procedures, spending, and end-of-life care intensity. Areas with more healthcare resources generally had higher utilization and spending but not better outcomes.
How to Engage Physicians in Best Practices to Respond to Healthcare Transform...PYA, P.C.
PYA Principal Kent Bottles, MD, spoke about physician engagement when it comes to value payment models during “How to Engage Physicians in Best Practices to Respond to Healthcare Transformation” at the Georgia Society of Certified Public Accountants’ (GSCPA) 2016 Healthcare Conference, February 11, 2016. Dr. Bottles discussed the difficulty of weaning physicians from fee-for-service payment models and the often-unappreciated reasoning behind the shift to value-based payment models. He also highlighted MACRA, MIPS, patient satisfaction surveys, Physician Compare, and the ProPublica Surgeon Scorecard.
Seeking patient feedback an important dimension of quality in cancer careAgility Metrics
1) A patient satisfaction survey was conducted with cancer outpatients to identify areas for improvement. Wait times and contacting healthcare providers by telephone received the lowest satisfaction ratings, despite prior interventions to address wait times.
2) Patients followed by a nurse navigator reported higher satisfaction with wait times than those without a nurse navigator.
3) The survey found overall high satisfaction rates, but identified wait times and telephone contact as ongoing priorities for enhancing the patient experience.
Unit 1Emergency Department Overcrowding Due to L.docxwillcoxjanay
This study aims to evaluate factors contributing to overutilization of emergency departments for non-urgent care through a questionnaire. It will be conducted in a rural North Carolina county at the local emergency department, which sees an average of 1300 visits per month. Participants will complete an informed consent and anonymous survey assessing reasons for their emergency department visit and potential influences on their decision to seek care there rather than primary care, such as availability of appointments, transportation barriers, and convenience. The goal is to understand utilization patterns to help address overcrowding challenges faced by many hospital systems.
The Healthcare Team as the Healthcare Provider: A Different View of the Patie...guesta14581
Presentation to the Ohio State Society of Medical Assistant's annual convention about the Patient Centered Medical Home and the role of the medical assistant
Rethinking, rebuilding psychosocial care for cancer patientsJames Coyne
Presented as the 8th Trevor Anderson Psycho-Oncology Lecture, September 8, 2014, Melbourne, Australia.
Discusses how psychosocial care for cancer patients needs to be reorganized so that a broader range of cancer patients are served. Routine screening for distress is unlikely to be an efficient means of countering tendencies of cancer care more generally becoming more organized around time efficiency and billable procedures. Psychosocial care for many cancer patients involves discussions, negotiations, and care coordination they cannot be well fit into the idea of a counseling session. The unsung heroes of providing such care are underappreciated social workers and oncology nurses.
Case Study "Using Real Time Clinical Data To Support Patient Risk Stratification in The Clinical Care Setting"
HealthInfoNet operates the statewide health information exchange in Maine. The exchange currently manages clinical and patient care encounter information on 97 percent of the residents of the State of Maine. The information is gathered in real time, standardized, and aggregated at a patient specific level to support treatment. For the past three years, HealthInfoNet has worked with HBI Solutions, Inc of Palo Alto, CA to utilize this real time clinical and encounter data to support the development of predictive analytic tools that risk stratify patient populations and individual patients for future incidence of disease, cost, and both inpatient and ambulatory care encounters. These real time predictive models have now been used in clinical care settings for a year. The presentation will cover both lessons learned to date from implementing and optimizing real time predictive analytic tools and the early finding of the impact that the use of these tools is having on patient care management, utilization and outcome.
Devore Culver
Executive Director & CEO
HealthInfoNet
The Future of the American Healthcare Delivery System in an Era of ChangePYA, P.C.
PYA Principal Dr. Kent Bottles, who is also PYA Analytics' Chief Medical Officer, gave the keynote address, "The Future of the American Healthcare Delivery System in an Era of Change at the Healthcare Business Intelligence Summit," September 19, 2013, in Minneapolis. Dr. Bottles discussed four key trends affecting the American healthcare delivery system: the Affordable Care Act (“ACA”), the digital revolution, big data, and social media. He examined how these trends together affect the way hospitals, providers, payers, employers, and government agencies adapt to the changing healthcare environment.
AHRQ Quality and Disparities Report, May 2015Joe Soler
The document is a presentation from the National Healthcare Quality and Disparities Report Chartbook on Care Coordination from May 2015. It discusses trends in care coordination measures from the report and provides data on various measures of care coordination, including rates of patients receiving discharge instructions, hospital readmission rates, and preventable emergency department visits. The goal is to assess quality of care coordination and identify areas for improvement, particularly in reducing disparities. Several charts display care coordination measure results over time and differences between demographic groups to examine health equity.
Redesigning methods of psychosocial intervention 2 10 13James Coyne
This document discusses redesigning psychosocial services for cancer patients. It notes that international standards for cancer care may not be practical or appropriate for all cultural contexts. When developing new services, it is important to evaluate appropriateness, involve stakeholders, and monitor implementation. Screening all patients for distress may not be feasible and could identify needs without solutions. Alternatively, all patients should have opportunities to discuss their experiences and concerns without screening. The goals of psychosocial care should be better symptom management, access to support, and specialized services for high-risk patients.
Empowering Healthcare Leaders: The Business Case for Language Access_10.3.14Douglas Green
Empowering Healthcare Leaders: The Business Case for Language Access provides a framework for calculating total potential encounters with limited English patients, the economic benefit and cost of not providing language access and a frame work to align the economic benefits with organizational goals under the Affordable Care Act.
Running head STRATEGIC PLAN FOR CHANGE1STRATEGIC PLAN FOR.docxtoltonkendal
Running head: STRATEGIC PLAN FOR CHANGE
1
STRATEGIC PLAN FOR CHANGE
2
Strategic Plan for Change
Jennifer Zimmerman
Walden University- NURS 6201
December 29, 2017
Improving Patient Experience who are Undergoing Chemotherapy from an Outpatient setting to an Inpatient Setting
1.
Introduction and Statement of the Problem
1.1.
What is the problem?
Outpatient chemotherapy sessions are sufficient in most organizations, especially for those receiving curative intent chemotherapy (Davidoff et al. 2013). The patients who meet the set criteria end up receiving supportive care post induction chemotherapy, as well as different cycles as other outpatients. Outpatient management can be made safe and the transition to inpatient more efficient, which is considered a challenge for most healthcare organizations. The problem at hand in this section has been adequately analyzed, which involves the transition of patients receiving chemotherapy from outpatient to inpatient in healthcare facilities.
1.2.
Why is it important enough to warrant a change?
Outpatient care especially for most patient has become a familiar concept that is driven by increased healthcare costs and more so, the increased demand for existing inpatient resources in different organizations (Joana et al. 1987). Improved supportive care in inpatient is also another reason for the need to embrace the transition, and patient wishes to spend the least amount of time, especially in waiting for service delivery in the outpatient setting. With these concepts in mind, it is important enough to warrant a change. Patient satisfaction ought not to be ignored in different healthcare organizations. There is a need to, therefore, be on the forefront in enhancing adequate care, and embracing inpatient plans for the chronically ill patients.
1.2.1.
Scholarly Reference #1
Joana, L., Mary, H., Alan, M., Andrew, B., & Steven, C., (1987). Case Mix and Changes in inpatient and outpatient chemotherapy. PubMed 8(4): 65-71.
In most healthcare settings, the therapy provided in outpatient has been associated with substantial tumors, chemotherapy involving high doses, and then followed by autologous stem cell transplantation. Outpatient administration of consolidation cycles has been reported, which emphasizes the major problem in this scholarly soured. According to the authors, the transition to inpatient to outpatient care should be considered and priority to solve the efficiency problems at hand.
1.2.2.
Scholarly Reference #2
Hayes, J. (2014). The theory and practice of change management. Palgrave Macmillan.
This source deals with theory and practice of change management. Change management is an adequate practice in the healthcare setting. There is a need for all healthcare organizations to be at the forefront to ensure that healthcare, both inpatient and outpatient are realized. The source provides and explains outpatient inefficiency for chronic patients as the worst problem in the medical profession. Th ...
David Haggstrom Regenstrief Conference SlidesShawnHoke
The document discusses approaches to measuring and improving cancer care quality through health information technology and data sharing. It proposes:
1) Measuring quality using longitudinal data from sources like cancer registries to track entire patient populations.
2) Implementing health information exchange and clinical decision support systems to provide real-time quality data and reminders to guide screening and follow-up care.
3) Addressing accountability for follow-up care through approaches like assigning responsibility to larger provider groups or enabling data sharing through personal health records.
Physician age and outcomes in elderly patients in hospial in the US: observat...Akshay Mehta
- This study examined the relationship between physician age and patient outcomes among elderly Medicare beneficiaries admitted to hospitals in the US from 2011-2014.
- The study found that patients treated by older hospitalists had higher 30-day mortality rates compared to patients treated by younger hospitalists, except for those treated by hospitalists with high patient volumes.
- Readmission rates did not meaningfully vary with physician age, while costs of care were slightly higher among older physicians. The results suggest that differences in practice patterns or quality measures between physicians of varying experience levels could influence patient outcomes.
Dr. Harold Freeman founded the first patient navigation program in 1990 to help reduce barriers to care for low-income cancer patients. A study he conducted between 1995-2000 found that the five-year cancer survival rate increased to 70% for low-income patients who received help from patient navigators, compared to only 39% in an earlier study without navigators. Research has shown that patient navigators increase patient compliance, decrease delays in care, and can increase patient satisfaction scores by explaining treatment plans and helping patients overcome barriers to care. While start-up costs may be high initially, patient navigators ultimately save health systems money by reducing unnecessary emergency room visits and improving health outcomes.
25 Champions of Shared Decision Making, selected by the staff of the Informed Medical Decisions Foundation. This is not a top 25 list, merely a list of 25 individuals the staff wanted to recognize.
This document discusses shared decision making initiatives in England. It describes 3 key programs - the Health Foundation's MAGIC program which developed decision aids and trained clinicians, the NHS Right Care program which created 38 online decision aids for conditions like cancer and joint replacements, and Bupa UK's treatment options service which engaged over 10,000 members through health coaching. It outlines successes of each program like cost savings, high patient satisfaction, and policy influence, but also challenges of sustainability, embedding in healthcare systems, and overcoming cultural barriers. The document advocates for further adoption of shared decision making in the NHS, expanding decision aid availability, and building awareness among patients.
This document summarizes a medical editors meeting about treatment options for peripheral artery disease (PAD). It discusses the development of an educational program about PAD for patients. The program aims to help patients make informed decisions about improving walking ability and reducing cardiovascular risk. Challenges in developing the program included communicating treatment benefits, comparing varied efficacy data, and addressing uninsurance coverage for supervised exercise. The document outlines strategies for addressing these challenges.
This document summarizes the results of a national survey of medical decisions. It found that 77% of Americans aged 40+ discussed at least one medical decision in the past two years. The most common decisions discussed were starting or stopping medication (52%) and discussing screening tests (59%). Knowledge about medical conditions was low, ranging from 20% to 84% correct depending on the condition. Discussion of pros and cons varied, from 6% to 84% depending on the decision. The decision process score, which measures how informed and collaborative the decision process was, ranged from 1.5 to 3.2 out of 5 depending on the decision. In the end, patients had surgery 42% of the time, took medication 79% of the
The document discusses using patient interviews to support patient decisions in medical care. It notes that patient interviews were initially used because patients should hear other patients' voices and be exposed to different choices. However, patient interviews are now being reexamined because they are relatively expensive and questions have been raised about their need as media moves to more web and mobile formats. While some argue patient interviews can be biasing, the organization finds them engaging and believes they can help patients understand options when used properly and not inherently bias decisions. More research is still needed on how different uses of interviews impact decision making.
The document summarizes the activities of the Content Development Team at the Foundation from 2012-2013, including program updates, new programs developed, and collaborations. Some of the key projects discussed include adapting decision aids for use in Australia, collaborating with outside organizations on grants and standards, and new partnerships to create medication decision aids with the American College of Cardiology.
Narratives play several roles in decision aids such as engaging patients, informing them, modeling behaviors, helping patients weigh trade-offs and clarify values, but they also raise some concerns. While narratives can make information more memorable, they risk focusing on outliers and distracting from facts. The evidence on whether narratives influence decisions is mixed, though they certainly have power. The document advocates using curated patient narratives in addition to factual information to complement rather than replace facts, mitigate potential biases, and represent both common and uncommon patient viewpoints and experiences.
This study examined factors that predict whether patients with depression choose to start or continue medication treatment, or discuss non-medication treatment options with their healthcare provider. The study found that patients with worse health status or who prioritize quick relief were more likely to take medication. Patients concerned about medication side effects or costs were less likely to take them. Minority patients and those without health insurance were more likely to discuss alternative options or less likely to take medication, possibly due to stigma or lack of access. Overall, patients appeared informed about their treatment decisions.
This study surveyed U.S. adults aged 40 and older about their medical decision making regarding cancer screening tests and medications for common conditions. It found that decision processes were generally poor across age groups. While knowledge about treatments was higher for medications than screening, all groups valued potential benefits highly. The oldest group (75+) reported less discomfort with some cancer screenings and less importance on costs or side effects of medications. The study concludes there is opportunity to better educate elderly patients and their doctors about estimated benefits, competing risks when considering screenings or adding medications.
Diana Stilwell, MPH, chief production officer at the Informed Medical Decisions Foundation, walks through the role of narratives in decision aids and how the available evidence relates to the Foundation approach.
This presentation was part of a Shared Decision Making Month webinar -- The Power of Narratives: How They Shape the Way Patients Make Medical Decisions.
Jack Fowler, PhD, senior scientific advisor at the Informed Medical Decisions Foundation provides an overview of the Foundation's path to developing decision aids that included patient narratives.
This presentation was part of a Shared Decision Making Month webinar -- The Power of Narratives: How They Shape the Way Patients Make Medical Decisions.
Victoria Shaffer, PhD, describes the the pros and cons of narratives and then explains her work to develop a system of classification for narratives as part of the solution. Victoria provides an overview of the narrative taxonomies she and her colleague have developed.
This presentation was part of a Shared Decision Making Month webinar -- The Power of Narratives: How They Shape the Way Patients Make Medical Decisions.
Karen Sepucha, PhD, describes what a good decision is, how we measure decision quality and how the decision quality instrument might be used.
This presentation was part of a Shared Decision Making Month webinar -- What Makes a Good Medical Decision? Defining and Implementing Decision Quality Measures.
Doctors need to ensure patients are informed, involved in the decision making process, and that the final decision aligns with what is most important to the patient. Measuring decision quality helps evaluate support strategies, assess provider support of patients facing medical decisions, and ensures informed patient input is included. The key elements of measuring decision quality are that patients know key facts, doctors meaningfully involve patients, and the decision aligns with patient priorities.
David Wennberg, MD, MPH, describes a recent randomized trial he was involved with that studied the potential of shared decision making to reduce costs among preference-sensitive conditions. David also explains the vision of the 20-member High Value Healthcare Collaborative.
This presentation was part of the Shared Decision Making Month webinar "Turning Shared Decision Making Policy into a Reality."
Ben Moulton, JD, MPH, provides an overview of the shared decision making policy landscape.
This presentation was part of a Shared Decision Making Month webinar -- Turning Shared Decision Making Policy into a Reality: Can We Really Improve the Quality of Care While Reducing the Costs.
Kristen Oganowski, CD(DONA) shares her experience as a parent/patient doula advocate.
This presentation was part of a Shared Decision Making Month webinar -- Maternity Care and Shared Decision Making: Improving Care for Mothers and Babies.
Kate Chenok, a director at Pacific Business Group on Health, provides the purchaser perspective on shared decision making and maternity care.
This presentation was part of a Shared Decision Making Month webinar -- Maternity Care and Shared Decision Making: Improving Care for Mothers and Babies.
Maureen Corry, executive director of Childbirth Connection, provides an overview of the state of shared decision making and maternity care.
This presentation was part of a Shared Decision Making Month webinar -- Maternity Care and Shared Decision Making: Improving Care for Mothers and Babies.
Jeff Belkora, associate professor at the University of California, San Franscisco, shares UCSF Breast Care Center's unique approach to support shared decision making: using student health coaches.
This presentation was part of a Shared Decision Making Month webinar -- Shared Decision Making in the Real World: Stories from the Frontline.
Mais de Informed Medical Decisions Foundation (20)
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
Keynote Address: Jack Wennberg
1. Ke y n o t e A d d r e s s
Aligning Incentives for Patient
Engagement
May 24, 2013
2. Unwarranted Variation in Health Care Delivery
and the Struggle for Reform
Aligning Incentives for Patient Engagement
Washington D.C.
May 24, 2013
John Wennberg
3. The Research in a nutshell
In Health Care, Geography is Destiny
Medical practice occurs within a local context: Per capita
expenditures, resource use and utilization vary extensively
among regions, communities and health care organizations.
4. The Research in a nutshell
In Health Care, Geography is Destiny
Medical practice occurs within a local context: Per capita
expenditures, resource use and utilization vary extensively
among regions, communities and health care organizations.
Much of this variation is unwarranted: It isn’t explained by
illness, evidence-based medicine or patient preferences.
The causes and remedies of unwarranted variation differ
according to the category of care.
5. Preference-Sensitive Care
• Involves tradeoffs -- more than one treatment exists and the
outcomes are different
• Decisions should be based on the patient’s own preferences – On
the ethic of informed patient choice
• But provider opinion often determines which treatment is used
8. The Dartmouth Atlas Project: 306 Hospital Referral Regions
Ongoing Study of Traditional Medicare Population USA
9. Knee replacement per 1,000 Medicare
enrollees
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
1992 2000 2007
Red dot = US average: 4.0 5.4 8.6
10. Relationship between rates of knee replacement per
1,000 Medicare enrollees in 1992 and 2007
0.0
4.0
8.0
12.0
16.0
0.0 4.0 8.0 12.0 16.0
Knee replacement (1992)
Kneereplacement(2007)
R2 = 0.62
11.
12. Determining the Need for Hip and Knee Arthroplasty:
The Role of Clinical Severity and Patients’ Preferences
• . . . Among those with severe arthritis, no more than 15%
were definitely willing to undergo (joint replacement), emphasizing
the importance of considering both patients’ preference and
surgical indications in evaluating need and appropriateness of
rates of surgery
13. Which Rate is Right?
Medical Necessity = clinically appropriate + informed patient choice
14. Which Rate is Right?
Medical Necessity = clinically appropriate + informed patient choice
Informed patient choice is an ethical imperative for uncovering “true”
demand for surgery & learning which rate is right.
15. Which Rate is Right?
Medical Necessity = clinically appropriate + informed patient choice
Informed patient choice is an ethical imperative for uncovering “true”
demand for surgery & learning which rate is right.
In the absence of informed patient choice, surgeons are at risk for
operating on the wrong patient: on patients who preferred another
treatment.
16. Which Rate is Right?
Medical Necessity = clinically appropriate + informed patient choice
Informed patient choice is an ethical imperative for uncovering “true”
demand for surgery & learning which rate is right.
In the absence of informed patient choice, surgeons are at risk for
operating on the wrong patient: on patients who preferred another
treatment.
Effective tools are available to improve decision quality and avoid
wrong patient surgery.
17.
18. Supply-Sensitive Care
Everyday services provided mainly to patients with medical
(non-surgical) conditions: physician visits, referrals to
specialists, MRIs, laboratory tests, screening exams and
hospitalizations, and stays in ICUs
19. Supply-Sensitive Care
Everyday services provided mainly to patients with medical
(non surgical) conditions: physician visits, referrals to
specialists, MRIs, laboratory tests, screening exams and
hospitalizations, and stays in ICUs
At issue is the frequency of use of such care, particularly in
managing chronic illness over time: “Which rate is Right?”
20. Supply-Sensitive Care
Everyday services provided mainly to patients with medical
(non surgical) conditions: physician visits, referrals to
specialists, MRIs, laboratory tests, screening exams and
hospitalizations, and stays in ICUs
At issue is the frequency of use of such care, particularly in
managing chronic illness over time: “Which rate is Right?”
Supply-sensitive care accounts for most of the more two-fold
variation in Medicare spending among regions.
22. Hospital resources invested in health care of Bostonians
compared to New Havenites
Resources Ratio: Boston
to New Haven
Beds per 1,000 1.55
Employees per 1,000 1.89
Per capita Spending 1.87
23. Standardized hospital discharge rates for medical
conditions: Boston and New Haven region (1994-95)
(Discharge ratio: Boston/New Haven in black)
Figure 8.2
1.64
1.14
1.66
1.58
1.72
2.17
1.52
1.89
3.06
1.50
0.0
0.5
1.0
1.5
2.0
2.5
AllMedical
Discharges
Uncomplicated
Pneumonia
Heart
Failure
Gastro-
enteritis
Cellulitis
COPD
Diabetes
Kidney&Urinary
TractInfections
Bronchitis
&Asthma
Angina
Pectoris
RatiotoU.S.average(1994-95)
Boston
New Haven
:
24. Hip Fracture
R2 = 0.06
All Medical
Conditions
R2 = 0.54
0
50
100
150
200
250
300
350
400
1.0 2.0 3.0 4.0 5.0 6.0
Acute Care Beds
DischargeRate
Association between hospital beds per 1,000 and discharges
per 1,000 among Medicare Enrollees: 306 Hospital Regions
26. A behavioral interpretation of variation in
frequency of use of supply-sensitive care
• The frequency of use is governed by the assumption that
resources should be fully utilized, i.e. that more is better.
• Specific medical theories and medical evidence play little role in
governing frequency of use.
27. Supply-Sensitive Care
Physician Visits per Decedent During Last Six Months of Life Among
Patients Assigned to Academic Medical Centers (2010 deaths)
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Cedars-Sinai Medical Center 72.6
NY-Presbyterian Hospital 39.1
Mass. General Hospital 34.7
Brigham & Women's Hospital 31.5
Beth Israel Deaconess 30.3
Boston Medical Center 29.2
UCSF Medical Center 28.3
Mayo Clinic-St. Mary's 21.3
Scott & White Memorial Hosp 19.8
NYU Langone Medical Center 58.5
Ronald Reagan UCLA Med Ctr 49.7
Mount Sinai Hospital 49.1
28. A behavioral interpretation of variation in
frequency of use of supply-sensitive care
• The frequency of use is governed by the assumption that
resources should be fully utilized, i.e. that more is better.
• Specific medical theories and medical evidence play little role in
governing frequency of use.
• In the absence of evidence and under the assumption that more is
better, available supply governs frequency of use.
29. Which Rate is “Right”?
More frequent use of supply-sensitive care isn’t resulting in better
outcomes:
30. Which Rate is “Right”?
More frequent use of supply-sensitive care isn’t resulting in better
outcomes:
• More than two-fold variation in frequency of use is uncorrelated
with prevalence of severe chronic illness and with outcome
measured by mortality.
31. Which Rate is “Right”?
More frequent use of supply-sensitive care isn’t resulting in better
outcomes:
• More than two-fold variation in frequency of use is uncorrelated
with prevalence of severe chronic illness and with outcome
measured by mortality.
• Technical quality of care tends to be better in low use regions.
32. Which Rate is “Right”?
More frequent use of supply-sensitive care isn’t resulting in better
outcomes:
• More than two-fold variation in frequency of use is uncorrelated
with prevalence of severe chronic illness and with outcome
measured by mortality.
• Technical quality of care tends to be better in low use regions.
• Patients rank their hospital experiences higher in low use regions.
33. Which Rate is “Right”?
More frequent use of supply-sensitive care isn’t resulting in better
outcomes:
• More than two-fold variation in frequency of use is uncorrelated
with prevalence of severe chronic illness and with outcome
measured by mortality.
• Technical quality of care tends to be better in low use regions.
• Patients rank their hospital experiences higher in low use regions.
• Care coordination is better in low use regions.
34. Which Rate is “Right”?
More frequent use of supply-sensitive care isn’t resulting in better
outcomes:
• More than two-fold variation in frequency of use is uncorrelated
with prevalence of severe chronic illness and with outcome
measured by mortality.
• Technical quality of care tends to be better in low use regions.
• Patients rank their hospital experiences higher in low use regions.
• Care coordination is better in low use regions.
• End of life care is less aggressive in low use regions.
35. Supply-Sensitive Care
Percent of Deaths Associated with ICU Admission Among Patients
Assigned to Academic Medical Centers (2010 deaths)
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
Boston Medical Center 27.8
NYU Langone Medical Center 23.8
UCSF Medical Center 22.7
Beth Israel Deaconess 22.2
Brigham & Women's Hospital 19.4
Mass. General Hospital 17.9
Mount Sinai Hospital 17.0
Mayo Clinic-St. Mary's 16.8
NY-Presbyterian Hospital 16.2
Scott & White Memorial Hosp 15.7
Ronald Reagan UCLA Med Ctr 40.6
Cedars-Sinai Medical Center 38.2
36.
37. Conclusion: Song et al.
The use of clinical or claims-based diagnoses in risk adjustment may
introduce important biases in comparative effectiveness studies, public
reporting and payment reforms.
Conclusion: Welch et al.
There is an inverse relationship between regional frequency of diagnosis
and the case fatality rate for chronic conditions.
Conclusion: Wennberg et al.
Adjusting for illness using HCCs, Iezzoni chronic illness and Charlson co-
morbidity index make regions with high visit rates seem to have lower
mortality and lower costs and visa versa.
In the states, despite early efforts to conduct health planning, the population served by a given health care organization is not know or ignored, despite 40 years of small area analysis. In the UK, budgets and other aspects of resource allocation have more or less been made on a geographic, per capita basis. However, under the new commissioning strategy, the UK is moving away from population-based medicine.
In the states, despite early efforts to conduct health planning, the population served by a given health care organization is not know or ignored, despite 40 years of small area analysis. In the UK, budgets and other aspects of resource allocation have more or less been made on a geographic, per capita basis. However, under the new commissioning strategy, the UK is moving away from population-based medicine.
Communities served by the nation’s leading academic medical centers show just as much variation.
Add 115% increase to match format for previous slde
In the states, despite early efforts to conduct health planning, the population served by a given health care organization is not know or ignored, despite 40 years of small area analysis. In the UK, budgets and other aspects of resource allocation have more or less been made on a geographic, per capita basis. However, under the new commissioning strategy, the UK is moving away from population-based medicine.
In the states, despite early efforts to conduct health planning, the population served by a given health care organization is not know or ignored, despite 40 years of small area analysis. In the UK, budgets and other aspects of resource allocation have more or less been made on a geographic, per capita basis. However, under the new commissioning strategy, the UK is moving away from population-based medicine.
In the states, despite early efforts to conduct health planning, the population served by a given health care organization is not know or ignored, despite 40 years of small area analysis. In the UK, budgets and other aspects of resource allocation have more or less been made on a geographic, per capita basis. However, under the new commissioning strategy, the UK is moving away from population-based medicine.
Communities served by the nation’s leading academic medical centers show just as much variation.
The effect of hospital bed capacity is to exercise a subliminal effect on the clinical threshold for admitting patients to hospital; the effect is seen across most acute and chronic medical conditions; but not for elective surgery, which generally isn’t correlated with regional variation in bed capacity.